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In-house vs. Outsourced Billing

In-house vs. Outsourced Billing. In-House Medical Billing. Pros Maintaining Control (long-time, trusted, hands-on employees) Capitalizing on Investment (trained medical billers and PM system) Proximity to Staff (when problems arise, walk across the office) Cons

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In-house vs. Outsourced Billing

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  1. In-house vs. Outsourced Billing

  2. In-House Medical Billing • Pros • Maintaining Control (long-time, trusted, hands-on employees) • Capitalizing on Investment (trained medical billers and PM system) • Proximity to Staff (when problems arise, walk across the office) • Cons • Increased Costs (labor, technology, office expenses) • Liability Issues (staff neglect of encounters, superbills, denials, theft) • Staffing Issues (finding qualified help, vacations, sick-time, turnover)

  3. Outsourced Medical Billing • Pros • Lower Costs (lower employee costs/expenses, no turnover issues) • Accountability (billing company offers reporting and accountability) • Consistency (contractual obligation for services) • Cons • Loss of Control (giving up control to a third party) • Variable costs (collection % results in charges based on volume)

  4. Additional Challenges for Consideration • Declining Reimbursement • Increase patient workload to stay even financially • Affordable Care Act (aka Obamacare) • Electronic Health Record deployment • Changing regulatory environment • Claims follow and denials management • Staff turnover, sick time, vacation time, etc.

  5. How much can you outsource? • EOB Management • Primary & Secondary Billing / Rebilling • Electronic Claims Submission • Medical Billing Forms (HCFA and UB-92 forms) • Line-item Payment Posting • Electronic Eligibility Verification • Patient Statement Cycling • Professional & Institutional Claims • Clean Claims Rules Engine • Workers Comp and No-Fault • Financial Reporting (Account, claim and line-item level) • Electronic Remittance Advice (EOB) • Electronic Superbill • Payment Plans and Collections • Patient Account Management

  6. Other Benefits of Outsourcing • Focus on patients and service quality • Reduced errors and improved accuracy • Decreased labor cost and overheads • Increase % of paid claims, reduced write-offs • Maximize reimbursement, revenue, cash-flow • Less employee stress and HR issues • Better compliance with regulations • 20% software cost saving with RCM services

  7. Thank you! CureMD Corporation 55 Broad Street, New York, NY 10004 Tel: (212) 509-6200 www.curemd.com

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